Natural history of lower urinary tract symptoms in treatment-seeking women with pelvic organ prolapse

Kowalski J1, Wiseman J2, Cameron A3, DeLancey J3, Hendrickson-Cahill W4, Jelovsek E4, Kirby A5, Kreder K1, Lai H6, Mueller M7, Siddiqui N4, Bradley C1

Research Type

Clinical

Abstract Category

Pelvic Organ Prolapse

Abstract 94
Live Bowel Dysfunction, Urogynaecology, Female & Functional Urology 3 - Here Comes the Trio!
Scientific Podium Session 11
Sunday 17th October 2021
18:50 - 19:00
Live Room 1
Pelvic Organ Prolapse Prolapse Symptoms Prospective Study
1. University of Iowa, 2. Arbor Research Collaborative for Health, 3. University of Michigan, 4. Duke University, 5. University of Washington, 6. Washington University in St. Louis, 7. Northwestern Medicine
Presenter
Links

Abstract

Hypothesis / aims of study
The natural history of overactive bladder (OAB) and other lower urinary tract symptoms (LUTS) in women with pelvic organ prolapse (POP), both treated and untreated, is not well characterized.  Women seeking care for bothersome LUTS at six tertiary centers were enrolled in an observational study and assessed a wide range of LUTS using the LUTS Tool at baseline, 3 months and 12 months. Our aims were to (1) determine baseline association between LUTS Tool scores and POP and (2) compare change in LUTS Tool scores from baseline to 12-months in women with and without POP. We hypothesized that the LUTS Tool scores would be associated with the presence of POP and that LUTS Tool responses are stable over time in patients with and without POP at baseline.
Study design, materials and methods
Women enrolled in a large observational cohort study of patients seeking care for bothersome LUTS were eligible. Those with missing LUTS Tool data or incomplete/inconsistent Pelvic Organ Prolapse Quantification (POP-Q) data were excluded. The presence of prolapse (yes/no) was identified at baseline if maximum vaginal descent (MVD: greatest of POP-Q points Ba, Bp or C) was >0. Participants who had POP surgery or pessary treatment between baseline and follow-up visits were considered treated. Primary outcomes included LUTS Tool scales (OAB, obstructive, stress incontinence; all scaled 0-100), LUTS Tool Severity and change in LUTS Tool scores from baseline to 12-months. For each scale, repeated measures (within subject) linear regression models were fit with scale as the outcome and prolapse group, age, body mass index, a comorbidity index, smoking status, diabetes, hysterectomy, baseline LUTS scale score, and LUTS treatment included as fixed-effect predictors. The study was designed to achieve >90% statistical power to detect differences as small as 0.4 standard deviations for less prevalent group comparisons such as those with prolapse versus not.
Results
371 women were included; 311 (84%) without and 60 (16%) with prolapse at baseline. Of those with prolapse, 36 (60%) were treated during follow-up. Those with prolapse were significantly older (64.6±8.7 vs. 55.3±14.1, p<.001), and less likely to be Black (2% vs. 15%, p=0.006). During follow-up, women with prolapse (vs. without) reported greater Kegel exercise (57% vs. 41%, p=0.034) and less OAB medication (12% vs. 28%, p=0.013) use. Other baseline factors and LUTS treatments (physical therapy, sling, onabotulinumtoxinA and neuromodulation) during follow-up did not differ by prolapse status. Figure 1 shows LUTS Tool scores over time by prolapse group. In multivariable models, interaction terms between prolapse groups and visits were not significant (all p>0.05). All LUTS Tool scores decreased at 3- and 12-month visits (mean changes ranged from -4.44 to -14.29, all p<0.001), but scores did not differ between prolapse groups.
Interpretation of results
LUTS Tool scores (OAB, obstructive, stress incontinence and total severity) were not associated with presence of POP. LUTS Tool scores decreased similarly over 12 months in patients with and without POP.
Concluding message
LUTS did not differ at baseline between women with or without prolapse in a treatment-seeking cohort. LUTS improved over time in women with treated POP, untreated POP and without POP.
Figure 1 Boxplot distributions of LUTS Tool scales by prolapse group over time
Disclosures
Funding U01DK099879, U01DK097780, U01DK097772, U01DK097779, U01DK099932, U01DK100011, U01DK100017 Clinical Trial No Subjects Human Ethics Committee E&I Review Helsinki Yes Informed Consent Yes
03/11/2024 12:58:38